Treatment and Dietary

Management:
OBJECTIVES
Relief pain
Healing of ulcer
Prevent recurrence and complication
Provide with adequate nutrition
To maintain continuous neutralization of gastric acid and
minimize acid secretions
To reduce mechanical, thermal, and chemical irritation
to the gastric mucosa

Treatment and Dietary Management:

Pharmacologic:
A. Agents that reduce intragastric acidity:
Antacids
Sodium bicarbonate
Calcium hydroxide
Magnesium or aluminium hydroxide

H2 receptor antagonist
Cimetidene
Ranitidine
Nizatidine
famotidine

Treatment and Dietary Management

Proton Pump Inhibitor ( Drug of choice)

Omeprazole
Esomeprazole
lansoprazole

B. Mucosal protective agents

Sucralfate
Prostaglandin analogs
Misoprostol

Bismuth compounds
Bismuth subsalicylates
Bismuth subcitrate potassium

Treatment and Dietary Management:

C. Anti H.pylori Therapy

Omeprazole 20 mg BID
Clarithromycin 250-500mg BID
Metrodinazole 500mg BID
Amoxicillin 1 gm BID

-given for 10-14 days

Treatment and Dietary Management

DIETARY Management
1. Adequate Calorie to maintain DBW
Determine DBW, BMR, and TER
2. High Protein Diet
To promote healing of ulcer
To buffer acid
Replace nitrogen loss
3. Adequate Carbohydrates
To provide energy and spare protein
Avoid: harsh foods and irritating fiber

Treatment and Dietary

Management
4. High Unsaturated Fats
Inhibits gastric acid secretion and motility by cholecystokinin
Caution: for older patient who are at risk for atherosclerosis.moderate intake of
fats. Example. Emulsified fats like butter are well tolerated
5. Small frequent meals
To afford rest to the ogan
To maintain constant neutralization of the acid
To minimize distention of the stomach thus minimizing gastric and HCL secretion
6. Restrict fibers
To reduce motility

Treatment and Dietary

Management
7. Avoid stimulatory agents
Caffeine alcohol and smoking
8. Avoid gas forming food
Cooked cabbage, milk, spiced and fried foods
9. Avoid Nsaid
Ketoprofen- most harmful

 Bland diets
are recommended for patients suffering from peptic ulcers. Such diets are
restricted in foods that are mechanically, chemically and thermally irritating
to the gastro-intestinal mucosa.
A bland diet includes foods that are soft, not very spicy, and low in fiber. If
you are on a bland diet, you should not eat spicy, fried, or raw foods. You
should not drink alcohol or drinks with caffeine in them.
The dietary modification in bland diets are therefore based on neutralizing
the gastric acid and decreasing the motility
It's also important that your diet doesn't eliminate foods that contain
important vitamins and minerals

Foods to eat on bland diet

Dairy products
These dairy items are generally considered bland foods.
Milk - Many bland diets allow all types of milk, including nonfat and buttermilk.
Yogurt - This includes flavored and plain yogurt, but keep in mind that certain
fruits can affect digestion.
Cheese - Some bland diets include all types of cheese. Others eliminate the
fattier cheeses based on which type of digestion or stomach upset you've
experienced. Yellow cheeses tend to contain more fat than white cheeses.
Ice cream - Due to the fat content in many ice creams, some bland diets will
exclude ice cream entirely. Others allow ice cream in moderation or ice creams
that do not contain nuts or certain types of fruits.

Protein Foods
Soy products - This includes tofu, soy yogurts, and soy milk.
Fish - Many types of fish, like herring, cod and trout, are
acceptable on a bland diet.
Baked and grilled meats - Some bland diets include red meat, but
they usually emphasize lean cuts of chicken, pork, and turkey.
Nut butters - Depending on the type of digestive problems you
experience, nut butters, like peanut and almond butters, may or
may not be acceptable. Check with your doctor.

Fruits and Vegetables

Cooked vegetables - The cooking process can make many
vegetables less acidic. Carrots, peas, and squash may be
included in your diet.
Canned fruits - Dieticians consider nearly all canned fruits
acceptable for those on a bland diet.
Fruit and vegetable juices - Juices from celery, carrots and apples
are typically recommended over more acidic juices like orange,
tomato and grape juices.

Carbohydrates
Low-sugar cereals Again, you will want to choose basic cereals
with no added fiber.
White or processed breads- are best for bland dieters. These
breads do not have as much fiber as whole-grain or unrefined
breads, making them easier on your digestive tract.
Oatmeal - In some cases, your doctor or nutritionist may suggest
oatmeal. However, this varies based on your condition.
Potatoes - This includes all colors and types of potatoes.

Deserts
Allowed: Jello, gelatin, custard, plain pudding. Plain cake,
pound cake, sponge cake, angel food cake, cookies, ice
cream and sherbert.
Avoid: All rich foods such as pies, pastries, candies,
chocolate, any with fruits not allowed, coconut or nuts.

Treatment and Dietary

Management
Vitamins

Requirements of nearly all vitamins remain normal. adequate amount of

vitamin C should be provided for the healing of ulcers and better iron
absorption.

Minerals

Care should be taken to include sources of iron and calcium in the diet.
Generally, bland diets are found to be low in iron and vitamin C due to the
restriction in fruits and vegetables and medicinal supplements may have to be
given.

BLAND DIET
Tender foods are used such as cooked vegetables, canned fruits,
and refined breads and cereals.

Bland diet
Dietary Guidelines and Food List
Use the following guidelines to individualize your meal plan:
1. Eat three regular meals a day without snacks since all food stimulates acid output.
2. Eat foods slowly, chew well and avoid stomach distention with large quantities of food.
3. Use milk sparingly because it stimulates gastric acid secretion.
4. Use salt and very mild seasonings. Avoid heavy spices such as chili peppers, black pepper,
chili powder and highly seasoned foods.
5. Dietary fiber may be added since there is no evidence that dietary is harmful.
6. Choose whole grain, enriched, or refined breads and cereals. Avoid large amounts of
unprocessed bran.
7. Cook by baking, boiling, broiling, roasting, stewing, microwaving or creaming. Avoid
frying.
8. Avoid caffeinated beverages, coffee and tea products because of the caffeine, theobromine,
and tannins.
9. Citric acid juices may be irritating to some individuals.
10. Avoid aspirin, nonsteroidal anti-inflammatory drugs, alcohol and smoking

A DAYS SAMPLE DIET Peptic Ulcer

Disease

SUMMARY
Eat smaller meals more often to enable the stomach contents to be continuously
diluted and neutralized. The quantity of food eaten should be small to avoid
overfilling the stomach and causing distention.
Eat in a calm environment.
Easily digestible fats like fat of whole milk, egg yolk, cream and butter should be
used in moderate amounts as they decrease the emptying time of the stomach
and reduce matality.
Try to avoid caffeine beverages such as coffee, cola and tea. Also avoid alcohol.
Cut down on, or stop smoking cigarettes.
Avoid excessive spices or concentrated meat broths and extractives.
Avoid fibrous nature of cereals, fruits and vegetables.
Avoid frequent use of aspirin or other drugs that may damage the stomach lining.
Individual responses or tolerances to specific foods may vary. The same food may
evoke different responses at different times depending on the stress factor.